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Bringing Birth Back

By Jonathan Beachy

Degree Finder For Nurses

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Bringing Birth Back:

The rise of cesareans and the movement to safely prevent them.

Historically, cesareans were a last resort to be used only when a mother was beyond help in order to save the baby. The death rate was 100%. Today, while they have saved countless mothers and babies, they are so commonplace that they comprise 1 in 3 births (32.8%) [1,296,070 out of 3,952,841 births – 2012]. The World Health Organization stands by their claim that only 10 – 15% of births are justified by a cesarean. Members of the medical community, armed with new research and standards, are helping families to bring birth back!

Cesarean Rates

1970: 5.5%

1991: 22.6%

2002: 26.1%

1975: 10.4

1992: 22.3%

2003: 27.5%

1980: 16.5

1993: 21.8%

2004: 29.1%

1983: 20.3%

1994: 21.2%

2005: 30.3%

1984: 21.1%

1995: 20.8%

2006: 31.3%

1985: 22.7%

1996: 20.7%

2007: 32.0%

1986: 24.1%

1997: 20.8%

2008: 32.3%

1987: 24.4%

1998: 21.2%

2009: 32.9%

1988: 24.7%

1999: 22.0%

2010: 32.8%

1989: 23.8%

2000: 22.9%

2011: 32.8%

1990: 22.7%

2001: 24.4%

2012: 32.8%

Why does it matter?

Because cesarean sections are considered to be major surgery and with that comes risk.

Risks for mom

The death rate is over 3.5x higher for cesareans: 13.3 per 100,000 women (low-risk planned caesarean) vs. 3.6 per 100,000 women delivering vaginally

The complication rate is over 2x higher for cesareans: 9.5% for cesareans vs. 4.5% for vaginal.

First stage-active: Labor arrest should not be diagnosed except for mothers who fail to progress…

with ruptured membranes

at least 6+cm dilated (instead of 4cm)

at least 4 hours of adequate contractions (instead of 2hr).

Second stage:

No maximum time length.

Labor arrest should not be diagnosed during second stage until at least 3 hours of pushing (instead of 2hr) [first birth] and 2 hours (instead of 1hr) [second+ birth].

2. Apply external pressure to turn babies in breech position

Apply external pressure to turn babies in breech position (

More than half can successfully be turned and delivered vaginally. Cesarean should only be considered if this fails

manually rotate babies in head down but undesirable position (Occiput posterior [‘sunny-side-up]). Mothers who rotate their babies have 9% chance of a cesarean birth compared to 41% who don’t manually rotate.

[Risk Ratio (RR) – the risk of an event for women receiving continuous support divided by the risk for women receiving usual care. A value of one implies that continuous support had no effect; less than one that the support reduced the risk of the event; more than one that the occurrence of the event increased.]

The support was most effective when it was someone who was neither a member of the hospital staff nor a member of the woman’s social network (like a doula).

Umm… what’s a doula? [14]

“doula” comes from ancient Greek meaning “a woman who serves”

from DONA.org: “a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period”